Provider Demographics
NPI:1578387692
Name:SMOKY MOUNTAIN WOUND CARE LLC
Entity type:Organization
Organization Name:SMOKY MOUNTAIN WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-415-8386
Mailing Address - Street 1:2169 KIRKWALL DR
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-2001
Mailing Address - Country:US
Mailing Address - Phone:865-415-8386
Mailing Address - Fax:
Practice Address - Street 1:2169 KIRKWALL DR
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-2001
Practice Address - Country:US
Practice Address - Phone:865-415-8386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty